Mouthguard having an extra-oral portion and an intra-oral portion

ABSTRACT

A mouthguard which has a generally U-shaped intra-oral portion for placement in a patient&#39;s mouth and a generally U-shaped extra-oral portion which is placed outside the patient&#39;s mouth. The intra-oral portion may be shaped for bilateral placement between the upper and lower anterior teeth or the upper and lower posterior teeth, or for unilateral placement between the upper and lower canine teeth. There are narrow indentations between the arms of the extra-oral and intra-oral portions.

BACKGROUND OF THE INVENTION

1. Field of the Invention

This invention relates to oral devices, appliances, mouthguards andmouth props used to prevent oral injuries of the soft tissues, i.e.,lips, cheeks, tongue, and of the teeth in comatose, decerebrate andgenerally anesthetized patients as well as dentally anesthetizedpatients.

2. Description of the Related Art

Uncontrolled, uncoordinated biting, chewing, grinding and clenchingmovements of the mandible may cause damage to oral soft tissues, such asthe tongue, cheek, mucosa, and lips, if these tissues become entrappedor impinged between the upper and lower teeth. Uncontrolled,uncoordinated biting, chewing, grinding and clenching movements of thejaws can also cause teeth and dental restorations to fracture and break.These consequences of oral injuries can precipitate the introduction ofblood, debris and other material in the oral cavity and present a riskto the respiratory system of the injured patient.

Persons who are comatose, heavily anesthetized, or decerebrate canunconsciously display powerful oral movements which are extremelydifficult to control and often cause traumatic lacerations andmutilation of the tongue, lips and cheeks. Persons whose mandibularnerve, lingual nerve and/or mental nerve is locally anesthetized fordental procedures, i.e., dental restorations and extractions, have aperiod of altered sensations to pain and pressure in their tongues,cheeks, and lower lips. Children and the developmentally disabledfrequently chew and bite these anesthetized oral soft tissues causinglacerations and mutilation of tissues which may lead to permanentdisfigurement.

Several oral devices have been tried in attempts to prevent further oraltrauma in patients who have bitten themselves. The devices for thepatients whose conditions are considered long-term, i.e. the comatoseand decerebrate are of a more permanent nature. One device usesintermaxillary fixation with arch wires in conjunction with hard oralacrylic devices. Some of the problems which can occur when the maxillaand mandible are wired together in this fashion include the inability ofthe patient to breath through his oral cavity, the inability of thepatient's caregiver to maintain a patient airway by suctioning mucus andoral secretions from the patient's pharynx and the inability of thecaregiver to deliver adequate oral hygiene measures to the patient.Tongue blades padded with gauze and wrapped with tape, hard and softrubber and plastic mouth props, and flexible and inflexible metal andplastic airways have been used. Some problems which occur with thesedevices include an inability to keep them in their intended positions,between the patient's upper and lower teeth, unless a caregiver ismanaging the placement and positioning of the device at all times. Ifthe patient opens wider than the device, as when yawning, the device maymove into his throat or airway. If the patient thrusts his tongueforward against the device, he can push it out of his mouth. If thepatient grinds his mandible from side to side he can also work thedevice out of his mouth or into his throat or airway. Customized softand hard acrylic biteguards which cover the occlusal, facial and lingualsurfaces of the upper and lower teeth have been used. In order tocustomize the acrylic biteguards to fit the patient's teeth and oralstructures, impressions or imprints of the patient's dental arches mustbe obtained. The dental impression procedure can present risks to thepatient's airway should the soft putty-like material be aspirated by thepatient. The customized soft and hard acrylic biteguards can bedislodged from the teeth with tongue movements and grinding movementsand create foreign body risks to the patient's airway and throat.

The protection used in the patients whose sensations to pain andpressure have been temporarily altered as a result of local mandibulardental anesthesia is frequently in the form of gauze padding or cottonrolls placed between the teeth on the non-anesthetized side of themouth. By propping the teeth opened, oral tissues are not easily bitten.This protective procedure does not work well with patients who areunable to understand the logic of the instructions nor with those whoare unable to comply with the instructions, i.e. children and thementally handicapped. Therefore, the gauze padding and cotton rolls arefrequently displaced, expelled and occasionally aspirated or swallowed.

Many different mouthguards have been designed to prevent mouth injury topatients. Some of these guards also have features particularly useful inkeeping the throat of a patient under general anesthesia from becomingobstructed. Many of the prior mouthguards have complicated structures toaccomplish these purposes.

The early patent of Freedland (U.S. Pat. No. 2,459,273) is for a shocktherapy mouthguard with a rubbery pad mounted between the ends of arigid handle. A longitudinal passage is formed on top of the handle onthe pad. The lower teeth of a patient are placed between two arcuateprojections on the lower surface of the pad. The disclosure of thispatent and all other patents and publications cited herein is herebyincorporated herein by reference.

Other devices are simpler in form, being essentially a single U-shape(U.S. Pat. No. 4,867,147 of Davis) or Y-shape (U.S. Pat. No. 2,694,397of Herms for a mouth prop with a flat handle having a recessed areabetween the handle and the arms positioned so that the upper front teethdo not touch the handle when the molars are positioned on the arms ofthe prop and having optional pads added to the top surface of the arms).

Even simpler is the disposable BITE™ jawlock of U.S. Pat. No. 3,971,370which is simply a tongue depressing stick with a polyethylene pad at oneend. For use in soft tissue oral protection and jaw positioning, a BITE™jawlock is placed on one or both sides of the oral cavity. Because theBITE™ jawlock does not fill the oral cavity, it is often difficult tokeep the two jawlocks in the correct place to prevent patient injury.

The patent of Ross (U.S. Pat. No. 2,833,278) is for a mouthguardcomprising an upright "H" form in multiple planes. The teeth of thepatient rest on the one portion and do not rest on the portions thatextend above and below the top and bottom of the portion on which theteeth rest.

Many teeth protectors have a horizontal surface for the teeth to biteupon and a vertical surface extending upward from the front of thehorizontal surface. See, for example, Brown (U.S. Pat. No. 1,302,004).

Some of the tooth guards have elaborate molded flanges for protection ofthe front teeth and an attached breathing tube (See U.S. Pat. Nos.2,669,988 of Carpenter; 2,521,084 of Oberto; 2,882,893 of Godfroy; and4,112,936 of Blachly).

Another standard type of teeth protector has a channel which surroundsthe teeth, and in some cases also assists in treating the teeth. See,for example, Newman (U.S. Pat. No. 4,944,947: a device with recessedareas between surrounding side areas in which to place the teeth;Grossberg (U.S. Pat. No. 3,124,129); Martin (U.S. Pat. No. 3,385,291:the device has an upper and lower channel which partially surrounds theteeth with a rubber like material in the channels molded to conform withthe gums and sides of the teeth); Hoef (U.S. Pat. No. 3,416,527: aU-shaped channel fabricated from a substance which will retain a liquid,with a liquid impermeable backing); Riddell (U.S. Pat. No. 3,060,935);and Castaldi (U.S. Pat. No. 5,031,638).

Other mouthguards are particularly designed for use by athletes, and areprimarily made to surround and protect all of the player's teeth, forexample, U.S. Pat. Nos. 3,496,939 of Gores and 5,082,007 of Adell. Othermouthguards are designed for use by persons undergoing operationsrequiring intubation, for example, U.S. Pat. No. 3,513,838 of Foderick,or to firmly depress and hold a patient's tongue, for example, U.S. Pat.No. 4,041,937 of Diaz.

Some of the devices are also designed to keep the tongue, lips andcheeks away from the teeth. See for example, Lee (U.S. Pat. No.2,614,560) and Davis (U.S. Pat. No. 4,867,147).

It is important that mouthguards used for patients be both inexpensiveto construct so that they can be disposable; be able to fit allpatients, i.e, with different sizes of oral cavities or differentnumbers and arrangements of remaining teeth using a minimum number ofmouthguard models; provide sufficient cushioning to minimize toothdamage; be resilient so as to withstand compression or perforation underbiting forces; be flexible so as to allow contouring or bending of theplanar single unit to adapt to the intra-oral and extra-oral surfaces;be nontoxic and non irritating to the oral mucosa or skin of thepatient; and allow the anesthetized patient to be ventilated or theconscious patient to breathe through his mouth while the mouthguard ispositioned in the oral cavity. It is also important that the deviceprevents the impingement and laceration of oral soft tissues, i.e.,tongue, cheeks, and lips.

The mouthguard used should be able to be securely positioned in the oralcavity so as to neither be dislodged posteriorly which could compromisethe patient's airway or throat or dislodged anteriorly which could expelthe mouthguard from the patient's oral cavity. Additionally, themouthguard should allow normal oral movements much as speaking, yawningand lateral movements of the mandible. The prior mouthguards generallyare deficient in one or more of these aspects.

Minneman's mouthguard (U.S. Pat. No. 5,235,991) has a thin, stiff,generally triangular planar portion capable of deflecting mouth andcheek tissues, with arms along one side of the triangular plane and asingle handle at an opposite end of the planar portion from the arms;and a compressible portion located on each arm and extending above andbelow the planar portion. This mouthguard is designed to prevent toothand soft tissue injury in patients who are receiving ECT, but does notaddress the problem of self-inflicted trauma in the conscious patient ormechanical retention of the positioned mouthguard in the oral cavity ofthe conscious or unconscious patient so that constant supervision andmanagement of the device by a caregiver is not necessary.

It is therefore an object of this invention to provide a mouthguardwhich can be manufactured inexpensively.

It is a further object of this mouthguard to have a minimum number ofintra-oral shapes and sizes in order to be able to fit all patients,i.e., with different sizes of oral cavities or different numbers andarrangements of remaining teeth.

It is a further objective of this invention to provide a mouthguardwhich is effective in minimizing tooth damage and oral soft tissuedamage to tongues, cheeks and lips.

It is a further object of this invention to provide a mouthguard whichallows a patient to breathe through his mouth or to be ventilated whilethe mouthguard is in the patient's oral cavity.

It is a further object of this invention to provide a mouthguard whichis resilient and able to withstand compression and perforation underbiting forces and be flexible so as to be bendable and adaptable inorder to contour to the intra-oral and extra-oral surfaces.

It is a further object of this invention to provide a mouthguard whichis non-toxic to intra-oral tissues as well as non-irritating toextra-oral tissues.

It is a further object of this invention to provide a mouthguard whichwill not obstruct resuscitation or mouth-breathing.

It is a further object of the invention to provide a mouthguard whichcan be mechanically secured into its position in the oral cavity by aheadstrap so as not to be displaced more posteriorly in the oral cavityor expelled out of the mouth.

Other objects and advantages will be more fully apparent from thefollowing disclosure and appended claims.

SUMMARY OF THE INVENTION

The mouth guard of the invention has two main portions: a smallerintra-oral portion and a larger extra-oral portion for placement outsidethe mouth.

The smaller intra-oral portion is presented in three forms: a firstembodiment places the biting forces bilaterally upon the upper and loweranterior teeth, a second embodiment places the biting forces bilaterallyupon the upper and lower posterior or molar teeth, and a thirdembodiment places the biting forces unilaterally upon the upper andlower canine teeth. The intra-oral portion and the extra-oral portionform bilateral narrow indentations at their common connection. TheseU-shaped spaces receive the corners of the mouth bilaterally.

The invention is flat and relatively thin (approximately 7 mm inthickness) yet the placement of the intra-oral portion between thechewing surfaces of the teeth which correspond to the selectedintra-oral embodiment or model prevents the other teeth from coming intocontact with one another. The mouthguard is made of a compressible,resilient, flexible material in its preferred embodiment. Thisflexibility of the material allows the mouthguard to be bent into a45°-75° angle at the connection between the intra-oral and extra-oralportions to contour the extra-oral portion to the shapes of the lowerlip and the cheeks. The central area of the extra-oral portion deflectsthe lower lip away from the lower anterior teeth.

The extra-oral portion is much larger than the intra-oral portion. Thislarger surface area aids in the stabilization of the mouthguard and thelength of the extra-oral arms makes the movement of the extra-oralaspect intra-orally very difficult.

Oval shaped holes are placed bilaterally in the most distal aspects ofthe arms of the extra-oral portions. These holes receive a preferablynon-elastic head strap which serves to maintain and stabilize themouthguard in its proper position in the oral cavity.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a front perspective view of a first embodiment of themouthguard of the invention which places the mouthguard's intra-oralaspect bilaterally between the upper and lower anterior teeth, i.e.canine to canine.

FIG. 2 is an elevational side view of the first embodiment of themouthguard of the invention.

FIG. 3 is a back perspective view of the first embodiment of themouthguard of the invention.

FIG. 4 is a front view of the first embodiment of the mouthguard of theinvention showing its location in an oral cavity.

FIG. 5 is a plan view of the first embodiment of the mouthguard of theinvention which may be used in a small oral cavity, with a size for alarger oral cavity shown in dotted lines.

FIG. 6 is a perspective side view of the end of a preferred linearfastening means for the mouthguard of the invention, which places theintra-oral aspect bilaterally between the upper and lower anteriorteeth.

FIG. 7 is a side view of a head of a patient with whom the firstembodiment of the mouthguard of the invention is being used.

FIG. 8 is a front perspective view of a second embodiment of themouthguard of the invention which places the mouthguard's intra-oralaspect bilaterally between the upper and lower molar teeth.

FIG. 9 is an elevational side view of the second embodiment of themouthguard of the invention.

FIG. 10 is a back perspective view of the second embodiment of themouthguard of the invention.

FIG. 11 is a front view of the second embodiment of the mouthguard ofthe invention showing its location in an oral cavity.

FIG. 12 is a plain view of the second embodiment of the mouthguard ofthe invention which may be used in a small oral cavity, with a size fora larger oral cavity shown in dotted lines.

FIG. 13 is a side view of a head of a patient with whom the secondembodiment of the mouthguard of the invention is being used.

FIG. 14 is a front perspective view of a third embodiment of themouthguard of the invention which places the mouthguard's intra-oralaspect unilaterally between the upper and lower canine teeth.

FIG. 15 is an elevational side view of the third embodiment of themouthguard of the invention.

FIG. 16 is a back perspective view of the third embodiment of themouthguard of the invention.

FIG. 17 is a front view of the third embodiment of the mouthguard of theinvention showing its location in an oral cavity.

FIG. 18 is a plain view of the mouthguard of the third embodiment of theinvention which may be used in a small oral cavity, with a size for alarger oral cavity shown in dotted lines.

FIG. 19 is a side view of a head of a patient with whom the thirdembodiment of the mouthguard of the invention is being used.

DETAILED DESCRIPTION OF THE INVENTION AND PREFERRED EMBODIMENTS THEREOF

Mouthguard 20 of the present invention provides a means of placing acushioning pad between certain upper and lower teeth in the oral cavitythus preventing other opposing teeth in the oral cavity from contractingone another. In particular, the mouthguard's structure providesprotection for the teeth and oral soft tissues, i.e., tongue, cheek, andlower lip during forceful closure, biting, clenching and grinding of thejaws in the patient who unconsciously or consciously produces thesemouth movements (comatose, decerebrate, generally anesthetized patientsor those who have altered sensations of pain and pressure followinglocal dental anesthesia of the mandible). As used herein the words "up"and "down" (and derivative words such as, upper and lower,respectively), and "left", "right", "front", and "back" refer to themouthguard 20 or one or more parts thereof when oriented for use in themouth of an upright person.

Mouthguard 20 of the invention is preferably planar (FIGS. 2, 9, 15)with an intra-oral portion 22 which is shown in three embodiments havingarms 26, 46 and 48 (FIGS. 1, 3-5; FIGS. 8, 10-12; and FIGS. 14, 16-18,respectively). All three embodiments have an extra-oral portion 24.Intra-oral arms 26 and 46 (FIGS. 1, 3-5 and FIGS. 8, 10-12) as well asthe extra-oral portion 24 of the first two embodiments are leftside/right side mirror images of each other about line A as shown inFIGS. 1 and 8. Therefore, these two models of the mouthguard of theinvention may be used with either flat side as the upper side for aparticular patient.

As shown in FIGS. 1, 3-5, 8, 10-12, 14, and 16-18, mouthguard 20 of theinvention is generally "U" or "V" shaped. The actual shape of themouthguard, and of each of the two main portions thereof, while beinggenerally U-shaped, broadens out at the "top" of the each "U" (or "V").

There are two opposite indentations 44 (one on the left side and one onthe right side of the mouthguard 20) which together form a centralconstricted area 34 which divides the mouthguard 20 into the two mainportions, intra-oral portion 22 and extra-oral portion 24. Constrictedarea 34 is a very narrow area extending between the intra-oral portion22 and extra-oral portion 24 of the mouth guard.

Intra-oral portion 22 is generally a broad "U" in shape (FIGS. 1, 3-5,8, 10-12). Two arms 26 or 46 of the intra-oral portion, in the first andsecond embodiments, respectively, extend an equal distance on eitherside of line A at the center of the constricted area 28 of theintra-oral portion 22. Arms 26 and 46 are of a sufficient width andlength to accommodate most or all of the anterior teeth (canines andincisors) in a person's mouth, so that when the mouthguard is in use thecanine and incisor teeth rest upon arms 26 while the other opposingteeth in the oral cavity i.e. premolars and molars, are held apart fromone another. The width of arms 26 is sufficient to extend beyond theteeth in order to deflect the lip tissues and depress the tongue awayfrom the teeth. The interior aspect of arms 46 (FIGS. 8, 10-12) ishollow with the exception of the most posterior or distal aspect of eacharm which is a solid cushion. The solid cushions at the most posterioraspect of arms 46 accommodate the molars in a person's mouth, so thatwhen the mouthguard is in use the molars rest upon the cushions whilethe other teeth in the oral cavity, i.e. premolars, canines andincisors, are held apart and rest in hollow space 50. The areasurrounding hollow space 50 maintains the integrity of the shape of theintra-oral portion. The back border 52 of this area depresses thetongue, while the front area deflects the cheeks and lips.

Hollow space 50 extends through to central constricted area 34 and intocentral portion 32 of the mouthguard. The central portion 32 then formsthe front border and aids in maintaining the integrity of the shape ofthe intra-oral portion.

Intra-oral portion 48 of the third embodiment shown in FIGS. 14, and16-18 is a unilateral arm shaped as a bent-finger-type projection. Thetip 54 of the projection extends past the midline A. This unilateralprojection is of sufficient width and length to accommodate the upper orlower canine teeth on one side of the oral cavity. The mouthguard may beflipped over to accommodate the upper and lower canine teeth of theopposite side of the mouth. When the mouthguard is in use in a person'smouth, the upper and lower canine teeth on only one side of the mouthrest upon this unilateral arm and the other teeth, i.e., molars,premolars, other canines, and incisors are held apart from one another.

Extra-oral portion 24 in all embodiments is also generally in the shapeof a "U", as is shown most clearly in the solid lines of FIGS. 5, 12 and18. Arms 30 extending in mirror image on either side of a line A in thecenter of central portion 32.

The shape of the preferred embodiment of extra-oral portion 24 of theinvention varies slightly from a simple "U" shape. Preferably there is aslight indentation 36 in the outer edge of extra-oral portion 24 so thatthe edge of extra-oral portion 22 appears like a shallow "W". The reasonfor this indentation is to allow flexibility in movement of the devicewhen adapting extra-oral arms 30 to the contour of the chin and cheeksof the user. Indentation 36 also designates the midline of themouthguard, thus aiding in the proper placement and alignment uponinsertion of intra-oral portion 22.

The relative position of each arm 26, 46 or 48 of intra-oral portion 22and the corresponding arm 30 of extra-oral portion 26 deflects the innersurfaces of the cheeks away from the teeth or edentulous ridges toprevent impingement, and intra-oral arms 30 stabilize the position ofintra-oral portion in the patient's mouth.

Preferably each extra-oral portion 24 has a hole 38 in each armextending therethrough as shown in FIGS. 1, 8 and 14, for attachment ofa linear fastening means 40 to mouthguard 20. A preferred linearfastening means is made of two matable pieces 42 of interlockingmaterial, such as VELCRO™ (FIG. 6). One piece 42 of the interlockingmaterial is preferably threaded through each hole 38 and adjusted to theappropriate position in hole 38 to hold mouthguard 20 in the desiredposition on the patient. The other piece 42 of interlocking material isthen mated with the first piece so that mouthguard 20 is held in thecorrect position between the mated interlocking pieces 42.

Alternatively, the linear fastening means may be made of a non-elasticfabric with adjustability for example, by means of snaps, buckles, hooksand eyes and the like, threaded through each hole 38 for placementaround the back of the head of the patient to hold mouthguard 20 on thepatient.

Mouthguard 20 is preferably made in one piece of a material having thecompressibility, durability and flexibility of polyethylene foam, rubberor other sturdy but compressible material, and most preferably is madeof polyethylene foam. Mouthguard 20 preferably is of uniform thicknessthroughout, preferably about 5-10 mm thick, and is preferably made in aseries of sizes for persons of different mouth sizes. Thus, there arepreferably at least two sizes, one for children and one for adults asshown in FIGS. 5, 12 and 18 by the solid and dashed lines, respectively.Mouthguard 20 is also preferably made in several models for persons withdifferent medical conditions and oral behaviors as well as differentnumbers and arrangements of remaining teeth.

Thus, with mouthguard 20 held generally horizontally with either flatside of mouthguard 20 uppermost, the invention is used as follows: themedical practitioner holds mouthguard 20 by extra-oral portion 24 andplaces mouthguard 20 in position in the patient's mouth so that arms 26,46 or 48 are located inside the mouth along the sides of the mouth, andthe flat side of each arm 30 is located outside of the mouth along thecheeks. When the patient's jaws clamp together, the teeth press intoeach intra-oral portion 22, 46 or 48, respectively, in the threeembodiments at the point where they contact mouthguard 20 (see FIGS. 4and 7). The firmness of the preferred compressible material keeps otherteeth from contacting one another thus preventing oral soft tissue frombecoming impinged, lacerated, perforated or torn.

Preferred relative dimensions of the invention for a small oral cavityand a larger cavity are shown in FIGS. 5, 12 and 18. Thus small mouthguard 20' has shorter arms 22' (or 46' or 48') and 24' than in thestandard adult model shown in dotted lines. In the preferred dimensions,for example, in the first embodiment of the invention the width of eacharm 26 at its widest point is about 2-5 cm and the width of each arm 30at its widest point is about 3 cm. The width of the mouthguard 20 fromoutermost tip of one arm 30 to the other arm 30 is preferably about 12.5cm. The width from back to front of the device in the central area ispreferably about 5 cm and the width of the arm 44 varies from about 1.5to 4 cm.

While the invention has been described with reference to specificembodiments thereof, it will be appreciated that numerous variations,modifications, and embodiments are possible, and accordingly, all suchvariations, modifications, and embodiments are to be regarded as beingwithin the spirit and scope of the invention.

What is claimed is:
 1. A mouthguard for a patient, comprising a singleplanar piece of compressible flexible material, said piece comprising anintra-oral portion and an extra-oral portion, said intra-oral portioncomprising two intra-oral curved arms and the extra-oral portioncomprising two extra-oral curved arms which extend in mirror image oneither side of a line in the center of said extra-oral portion, saidextra-oral arms being longer than said intra-oral arms, said extra-oralportion having a W-shaped outer edge with a central indentation betweensaid extra-oral curved arms to allow flexibility of the mouthguard,wherein said extra-oral portion is generally curved around and parallelto said intra-oral portion, wherein each said intra-oral curved arm isof a size enabling said intra-oral curved arms to fit in the mouth ofsaid patient, and each said intra-oral arm is separated from theextra-oral portion by a side indentation, wherein said intra-oral curvedarms together form a U-shaped intra-oral portion having the sideindentations along the outer edge of said U-shaped intra-oral portion,for placement of said intra-oral portion between said patient's upperand lower teeth, wherein when said mouthguard is placed in the mouth ofthe patient each side indentation receives a corner of the mouth and theextra-oral arms extend along the cheeks of the patient on each side ofthe patient's face.
 2. The mouthguard according to claim 1, wherein theextra-oral portion has a hole extending through each arm for attachmentof a linear fastening means to the mouthguard.
 3. The mouthguardaccording to claim 2, further comprising a linear fastening meansfastened to the mouthguard.
 4. The mouthguard according to claim 3,wherein said linear fastening means comprises matable pieces ofinterlocking material, wherein one of said matable pieces ofinterlocking material is threaded through each of the holes.
 5. Themouthguard according to claim 1, wherein said compressible flexiblematerial is polyethylene foam.
 6. The mouthguard according to claim 1,further comprising a linear fastening means fastened to the mouthguard.7. The mouthguard according to claim 6, wherein said linear fasteningmeans comprises matable pieces of interlocking material, wherein one ofsaid matable pieces of interlocking material is threaded through each ofsaid holes.
 8. The mouthgard according to claim 1 wherein saidmouthguard has an interior centrally located hole therethrough.